Attachment J.4 Past Performance Questionnaire (1).docx

ATTACHMENT J.5 - PAST PERFORMANCE QUESTIONNAIRE

Offeror - please fill out the following questionnaire as clearly and as objectively as possible. The information you provide will be used for source selection purposes. Offeror, please send the completed questionnaire (Section A by the Offeror and B by the Reference) directly to the United States Agency for International Development (USAID) in Lebanon by email to WSCLebanonProposals@usaid.gov by the time and date indicated on the RFP cover page.

SECTION A: (To be filled by the Offeror)

Offeror's Name:

Was the Offeror the Prime or Subcontractor on the project:

Project Name:

Project Scope/Description:

Period of Performance: Dollar Value of Contract:

Primary Location(s) Work: ______________________

Name of Contact Person: _Phone:

Date Contacted: Employer:

Contact’s Role or Knowledge of the Project:

SECTION B: (To be filled by the contact person named in Section A above)

PPIRS: “QUALITY”: 1. Please comment on your satisfaction with the Contractor’s quality of work:

PPIRS: “SCHEDULE”: 2. Please comment on the Contractor’s timeliness of contract performance: ______

PPIRS: “MANAGEMENT”: 3. Please comment on the quality of your relations with the Contractor during contract performance:

PPIRS: “COST CONTROL”: 4. Please comment on the Contractor’s ability to control costs:

PPIRS: “REGULATORY COMPLIANCE”: 5. Please comment on the contractor’s ability to comply with applicable regulations:

PPIRS: “SMALL BUSINESS CONCERNS”: 6. For prime offerors who are not small business concerns, please comment on the Contractor’s utilization of Small Business concerns as subcontractors, including efforts in achieving small business participation goals:

Please provide comments on Contractor’s Key Personnel:

Other Comments:

Signature of the Referee:

[END OF ATTACHMENT J.4]

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